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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100406317
Report Date: 01/08/2020
Date Signed: 01/08/2020 02:20:45 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:FUSD-KIRKFACILITY NUMBER:
100406317
ADMINISTRATOR:MATHIES, DEANNAFACILITY TYPE:
850
ADDRESS:2000 E. BELGRAVIATELEPHONE:
(559) 441-3028
CITY:FRESNOSTATE: CAZIP CODE:
93706
CAPACITY:22CENSUS: 14DATE:
01/08/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Lead Teacher, Martha CornejoTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Jose Penate conducted a Case Management - Incident inspection for an incident which occurred on 11/08/2019. LPA met with Lead Teacher, Martha Cornejo (LT). LPA toured facility inside and outside and took census.

On 11/08/2019 LT reported an incident that occurred in the Pre-K classroom causing injury to a child in care. LT stated that on the day of the incident, the time of was during clean up time and transitioning into group ending activity. Children were all sitting on the carpet, LT observed a play dish left out from play time and she asked for a volunteer to go and place the dish in the proper area. Child #1 volunteered to place the item in the proper area and LT stayed with all other children on the carpet. Assistant Teacher was in the classroom cleaning tables and countertops while children were all located at the carpet. LT stated that she did not observed the fall because she was the other children at the carpet which is about 5 to 10 feet from the area where child #1 was injured. LT stated that she heard a thump, she then proceeded to go and help the child from the floor, when child was picked up from the floor LT then observed the cut under the eyebrow that was causing blood to come out profusely. LT had Assistant Teacher contact the main office for the Vice Principle and Nurse to come to the classroom and assist. Paramedics were called and Child #1 was transported to Fresno Community hospital where child was given stitches for the cut.

LPA toured classroom for any obstructions that would not allow proper supervision by staff at anytime. LPA observed that all furniture and equipment is placed in proper locations to allow supervision and view at all times.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations no deficiencies are observed today.

Site Visit Notice posted on the parent board. Exit interview was conducted with Lead Teacher, Martha Cornejo.

SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Jose PenateTELEPHONE: (559) 341-5860
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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